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Haematoma block or Biers block for Colles fracture reduction in the accident and emergency department--which is best?

机译:在急诊室使用血肿阻滞或Bier阻滞减少Colles的骨折-哪个最好?

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摘要

OBJECTIVE: To offer clear guidance on the anaesthetic management of Colles' fractures in the accident and emergency (A&E) department in the light of the conflict between existing reports and current trends, and to address the issue of alkalinisation of haematoma blocks. METHODS: This was a two centre, prospective, randomised clinical trial with consecutive recruitment of adult patients with Colles' fractures requiring manipulation to receive either Bier's block or haematoma block. There was subsequent blinded randomisation to alkalinised or non-alkalinised haematoma block. RESULTS: 72 patients were recruited into the Bier's block group, and 70 into the haematoma block group. Bier's block was less painful to give than the haematoma block (median pain score 2.8 v 5.3; P << 0.001), and fracture manipulation was also less painful in the Bier's block group (median pain score 1.5 v 3.0; P < 0.01). There was no significant difference in overall A&E transit time between the two groups. There was better initial radiological outcome in terms of dorsal angulation in the Bier's block group (-3.6 degrees v 2.1 degrees; P = 0.003). More remanipulations were required in the haematoma block group (17/70 v 4/72; P = 0.003). There was a trend towards decreased pain on administration of the alkalinised haematoma block when compared with non-alkalinised haematoma block, but this did not reach significance. There was no difference in pain score on fracture manipulation. There were no complications in either group. CONCLUSIONS: Bier's block is superior to haematoma block in terms of efficacy, radiological result, and remanipulation rate; transit times are equal, both procedures are practical in the A&E environment, and there were no complications. Bier's block is the anaesthetic management of choice for Colles' fractures requiring manipulation within the A&E department.
机译:目的:鉴于现有报告和当前趋势之间的冲突,为急诊科(A&E)的Colles骨折的麻醉管理提供明确的指导,并解决血肿块碱化的问题。方法:这是一项两中心,前瞻性,随机临床试验,连续招募患有Colles骨折的成年患者,需要对其进行操作以接受Bier阻滞或血肿阻滞。随后进行了对碱化或非碱化血肿块的盲法随机分组。结果:72例患者被分为Bier阻滞组,70例属于血肿阻滞组。与血肿阻滞相比,Bier阻滞的痛苦要小(中位疼痛评分2.8 v 5.3; P 0.001),Bier's阻滞组的骨折操作疼痛也较小(中位疼痛评分1.5 v 3.0; P <0.01)。两组之间的总体A&E通过时间没有显着差异。在Bier阻滞组中,在背侧角度方面具有更好的初始放射学结果(-3.6度vs 2.1度; P = 0.003)。血肿阻滞组需要更多的再手术(17/70 v 4/72; P = 0.003)。与非碱化血肿块相比,碱化血肿块的给药有减轻疼痛的趋势,但是这没有显着意义。骨折操作的疼痛评分没有差异。两组均无并发症。结论:在疗效,放射学结果和再手术率方面,比尔阻滞优于血肿阻滞。转运时间相等,两种程序在A&E环境中都是可行的,并且没有并发症。 Bier阻滞是需要在急症室进行操作的Colles骨折的首选麻醉管理方法。

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